老年高血压患者血压昼夜节律与腔隙性脑梗死、脑白质病变的关系

Relationship between circadian rhythm of blood pressure and lacunar infarction and white matter lesions in elderly hypertensive patients

目的 探讨老年高血压患者血压昼夜节律变化与腔隙性脑梗死（LI）和脑白质病变（WML）的关系.方法 选择2011年4月至2014年2月河北医科大学附属哈励逊国际和平医院门诊及住院高血压患者126例,年龄≥60岁,均进行动态血压监测及头颅MRI检查,同时收集患者的临床和实验室资料.将患者分为杓型组（48例）和非杓型组（78例）.结果 非杓型组24 h SBP[（136.39±12.45）mm Hg]、dSBP[（138.78±11.67）mmHg]、nSBP[（133.56±11.7）mmHg]明显高于杓型组,非杓型组ASBP％为3.38±1.96,明显低于杓型组的11.54±2.41,两组患者24 h SBP、dSBP、nSBP、ASBP％比较差异有统计学意义（P均＜0.05）.非杓型组LI46例（58.97％）、WML 41例（52.56％）,杓型组LI 13例（27.08％）、WML 11例（22.92％）,非杓型组LI、WML的发生率明显高于杓型组,两组比较差异有统计学意义（P＜0.01）.结论 对于老年高血压患者,非杓型高血压可增加LI和WML的发生率.有效降低夜间血压、恢复杓型节律,有助于减轻靶器官损害.

Objective Discussion on the circadian rhythm of blood pressure in elderly hypertensive patients with lacunar infarction and cerebral white matter lesions relationship. Methods Choose in April 2011 to February 2014, Hebei Medical University affiliated Harrison International Peace Hospital outpatient and inpatient age of 60 or more hypertension, 126 patients with ambulatory blood pressure monitoring and MRI examination of the head, and at the same time the collection of clinical and laboratory data of the patients. The patients were di- vided into 48 cases of dipper type group and 78 cases of non dipper type group. Results Non dipper type group 24 h SBP（ 136.39±2.45 ）mm Hg, dSBP（ 138.78±11.67）mm Hg, nSBP（ 133.56±11.7）mm Hg was significantly high- er than the dipper type group, non dipper type group ASBP% was 3.38±1.96, significantly lower than the dipper type group is 1154±2.41. The 2 groups had statistical significance in patients with 24 h SBP, dSBP, nSBP, ASBP% difference（P〈O.05）. Non dipper type group LI 46 cases（58.97%）, WML 41（52.56%）, Dipper type group LI 13 cases（27.08% ）, WML 11 （22.92%）. The incidence of non dipper type group LI and WML was significantly higher than that of dipper type group. The two groups had significant difference（P〈0.01 ）. Condusion In elderly hyper- tensive patients, non dipper type hypertension can ncrease the incidence of LI and WML rate, effectively reduce the nocturnal blood pressure, restore the dipper rhythm helps to reduce the damage of target organs.